Healthcare Provider Details

I. General information

NPI: 1336829100
Provider Name (Legal Business Name): JENAH HABERMEHL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SW SAINT LUCIE CRES STE 107
STUART FL
34994-2860
US

IV. Provider business mailing address

615 SW SAINT LUCIE CRES STE 107
STUART FL
34994-2860
US

V. Phone/Fax

Practice location:
  • Phone: 772-631-2314
  • Fax:
Mailing address:
  • Phone: 772-631-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENAH HABERMEHL
Title or Position: PSYCHOTHERAPIST
Credential: LMHC
Phone: 772-631-2314